Forms & Resources |
Forms
The following forms are used frequently when doing business with us.
- Ultimate Care HHS Nurse's Notes Form
(Requires Acrobat, 300k; fill out and fax to (972) 262-5768)
- Ultimate Care Employment Application Form
(Requires Acrobat, 615k; fill out and email per instructions or fax to (972) 262-5768) - Authorization Form
- Medicare Coverage Database - ICD-9 Code Finder
- Community-Based Alternatives Provider Manual
- Community Care Provider Forms
Resources
- Palmetto GBA's About Beneficiaries Page
- Palmetto GBA's Medicare Eligibility Page
- Medicare Eligibility Check
- Medicare's Long Term Care Guide
Note: These links will take you to third-party web sites outside of our control.
Some of the forms available from the links above require the free Adobe Reader. You may download it from the Adobe web site if you do not already have it installed.
Additionally, you may require the free Acrobat Accessibility Reader for PDFs. You may also download it for free from Adobe's Accessibility web site.
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